With the start of a new school term, pharmacy teams are an important source of reassurance and advice, helping parents to manage a variety of common childhood conditions, reports Kathy Oxtoby…

The start of the new school term is an ideal time for pharmacists to support children and their families. From head lice and verrucas, to coughs, colds and chickenpox, pharmacists are well placed to offer advice and products to help parents deal with a host of health problems that can affect their children.

“Community pharmacy is an accessible first point of call to deal with common ailments and minor conditions over the counter, including children’s conditions that are especially common this time of year,” says Alwyn Fortune, pharmacy policy and engagement lead, Wales, at the Royal Pharmaceutical Society.

Head lice: still a ‘taboo’ condition

Head lice - small grey/brown insects that live in human hair and feed on blood from the scalp - are very common in young children and their families. ¹ Close hair-to-hair contact is usually needed to pass lice on. ¹ One in ten primary-aged children have this condition at any one time. ^{1 2}

Head lice can have an impact on children’s social and emotional wellbeing. It is still seen as a “taboo” condition, that is incorrectly associated with dirty hair, says Mr Fortune. “And it can be very upsetting and distressing for some children, having head lice crawling in their hair.”

“There’s a stigma attached to head lice,” says Lila Thakerar, superintendent pharmacist at Shaftesbury Pharmacy, Harrow. “Children can feel isolated and very conscious of the condition, and other children may not want to play with them or sit next to them in class.”

Pharmacists can help tackle that stigma, and can reassure parents that head lice are “not a hygiene matter, and can be found in healthy hair”, says Ade Williams, lead pharmacist at Bedminster Pharmacy, Bristol.

Typical signs and symptoms of head lice are an itchy scalp and a feeling like something is moving in the hair. ³The only way to be sure someone has head lice is by finding live lice, which can be done by wet combing their hair from root to end - using plenty of conditioner - with a fine toothed detection comb, which can be purchased at pharmacies. ³

A wide range of treatments are available in different formats, and pharmacy teams can advise families which will suit them best, based on convenience and lifestyle, says Ms Thakerar.

Pharmacists should stock a comprehensive range, which includes market leaders and innovation within the category, and offer patients a choice of treatment options such as mousses, liquids, sprays and lotions, overnight treatments, and 10-15 minute preparations.

Wet combing or dimeticone 4% lotion is recommended first-line for pregnant or breastfeeding women, young children aged 6 months to 2 years, and people with asthma or eczema. ⁴

Head lice prevention and after-care involves wet combing through the hair to remove any remaining lice on days 1, 5, 9, and 13), and treating all affected family members to avoid reinfection. ⁴

Warts and veruccas: good hygiene to prevent spread

Warts are small, rough growths that can appear anywhere on the skin but are commonly seen on the hands and feet.⁵ They are usually skin coloured, can be round and flat - plane warts - and may appear in a cluster - known as mosaic warts, says Ms Thakerar.

Warts are caused by an infection of the skin with the human papillomavirus (HPV). ⁵ They are usually spread by direct skin-to-skin contact, or indirect contact with contaminated floors and surfaces, says Mr Fortune.

Warts usually go away on their own, but may take months or even years to disappear. ⁶ Pharmacists can stock creams, plasters, and sprays to treat warts. Treatments are typically based on salicylic acid preparations, which require application directly onto the wart to burn it away, and some products come with an emery board to file away the dead skin says Mr Fortune.

Parents should be advised that when treating children’s warts it is important to protect the healthy skin around the wart to avoid unnecessary skin erosion, says Ms Thakerar.

A verruca is a wart with a black dot in the middle which appears on the sole of the feet, and can be transmitted through skin-to-skin contact, and in public places like swimming baths and gyms. Its treatment and application is the same as for other warts, and includes patches impregnated with corrosive medication. If verrucas keep coming back after treatment, children should be referred to a GP, advises Ms Thakerar.

To help prevent the spread of warts and veruccas, Mr Williams advises hand washing, not sharing towels or socks, and avoiding walking barefoot in public places, like swimming baths. And Mr Fortune says it is important to advise parents that their children should not pick at their warts or it will inflame them and increase the chance of their spreading.

Other back to school conditions

Personal hygiene is “a priority” to protect children from back-to-school viruses, says Ms Thakerar. However, she says that in the school environment it is difficult to avoid being exposed to infectious conditions like coughs and colds. Parents can be advised to manage their children’s cold symptoms with lots of fluids, and bed rest, she says.

Mr Fortune says paracetamol  - in its liquid form for younger children - can be recommended to bring down a high temperature, and pharmacists can also suggest decongestants, and cough linctus, including sugar free versions.

Chicken pox is another infectious condition where pharmacy can provide support. Parents can manage their child’s chicken pox symptoms with creams and lotions to sooth itchiness and irritation, which can be applied directly to spots, and ensure they drink lots of fluids, and wear lose fitting clothing, says Mr Fortune.

Extremely contagious, scarlet fever symptoms include a high temperature, sore throat, swollen glands, a rash, and a white coating on the tongue that peels, leaving it red and swollen, explains Mr Fortune. “In the vast majority of cases scarlet fever will clear up on its own, but if the child becomes confused, or listless, and their temperature doesn’t come down, then parents should seek help from their GP,” he advises.

Earache in children can be managed with pain relief such as paracetamol, and tends to get better on its own, says Mr Fortune. However, if the child is still unwell after three days they may require antibiotic ear drops or ear sprays, he says.

Going back-to-school can be a stressful time for children, resulting in sleep problems and anxiety. “This is an opportunity for  pharmacy to give parents advice about good sleep hygiene, and also to advise on the importance of talking to children about their anxieties,” says Mr Williams.

With any back-to-school condition, it is important for pharmacists to offer parents reassurance. “Understandably, parents may come to the pharmacy alarmed - that a child at school has, say, head lice, or chicken pox,” says Ms Thakerar.

“Pharmacists need to reassure them that these are normal childhood conditions, and give appropriate advice to treat their children’s symptoms.”

References

1. Patient UK (2022) Head Lice and Nits. https://patient.info/childrens-health/head-lice-and-nits
2. Patient UK (2022) Should schools or parents be fighting nits? https://patient.info/news-and-features/should-schools-or-parents-be-fighting-nits
3. NHS (2021) Head lice and nits. https://www.nhs.uk/conditions/head-lice-and-nits/
4. National Institute for Health and Care Excellence (NICE) (2021) Scenario: management of head lice. https://cks.nice.org.uk/topics/headice/management/management/#:~:text=Wet%20combing%20or%20dimeticone%204,contact%20time%20to%20kill%20eggs
5. NICE (2020) Warts and verrucae. https://cks.nice.org.uk/topics/warts-verrucae/
6. NHS (2020) Warts and verrucas. https://www.nhs.uk/conditions/warts-and-verrucas/